Anesthesia | Sedation Evaluations

Nevada regulates general anesthesia, moderate sedation and related site approval through NRS 631 and NAC 631. A dentist may not administer or directly supervise general anesthesia, minimal sedation, moderate sedation, or deep sedation unless the dentist holds the permit required by the Nevada State Board of Dental Examiners. Nevada also separates the approval of the person from the approval of the location. In practice, that means the dentist must hold the appropriate administrator permit, and the office must obtain site approval when anesthesia or sedation is provided at that location by another qualified permit holder. 

To administer general anesthesia in Nevada, a dentist must be licensed in Nevada and must meet the Board’s training and competency requirements. That includes current ACLS or an equivalent Board-approved course, plus advanced education in anesthesiology beyond dental school or completion of a CODA-approved graduate program in oral and maxillofacial surgery or dental anesthesiology. A dentist who holds a general anesthesia permit may administer general anesthesia, deep sedation, moderate sedation, and minimal sedation to patients of any age. 

If the treating dentist does not personally hold the general anesthesia permit, the office may still offer these services only if a Nevada dentist with the proper permit administers the anesthesia and the office has a certificate of site approval for that location. Before treatment, the dentist must obtain written patient consent, document a medical history, and maintain a properly equipped facility with supervised auxiliary personnel certified in basic CPR. A general anesthesia permit holder may also employ a certified registered nurse anesthetist, but the permit holder must remain physically present and directly supervise the administration.

General Anesthesia Site Standards

A site used for general anesthesia must be equipped for safe delivery of anesthesia, patient monitoring, emergency response, and recovery. That includes an operatory large enough for the treatment team, a chair or table that supports airway management and CPR, adequate lighting, suction, oxygen delivery, a recovery area, and the emergency and monitoring equipment required by NAC 631. Records must be complete and must include the patient’s medical history, physical evaluation, ASA classification, vital signs, drugs administered, timing, procedure length, and any complications. The office must also maintain the required emergency drug categories for general anesthesia and deep sedation.

If general anesthesia or deep sedation is provided to a patient 12 years of age or younger, the office must also have the pediatric equipment required by regulation, including pediatric ambu bags and masks, pediatric blood pressure cuffs, pediatric laryngoscope blades, appropriately sized endotracheal tubes and connectors, pediatric pads for defibrillation, and small oral and nasal airways. Under the Board’s adopted 2024 regulation, the pediatric emergency-drug add-on now includes appropriate dosages of epinephrine or a pediatric epinephrine auto-injector.

For Nevada regulatory purposes, the adult moderate sedation category applies to patients 13 years of age or older. To qualify, a dentist must complete either a Board-approved course of at least 60 hours dedicated to moderate sedation and successfully administer moderate sedation as the operator on at least 20 patients, or complete CODA-approved specialty training with equivalent sedation education plus valid ACLS or a Board-approved course in medical emergencies and airway management.

A dentist may provide moderate sedation for patients 13 and older by personally holding either a general anesthesia permit or the applicable moderate sedation permit. If another Nevada dentist with the proper permit will administer the sedation, the office must obtain a certificate of site approval for each location where the sedation will be provided. The dentist administering or directly supervising the sedation must be physically present, and moderate sedation may not be administered to more than one patient at a time unless each patient is directly supervised by a person authorized by the Board to administer moderate sedation.

Moderate sedation sites must still meet the Board’s core safety, recordkeeping, and emergency response requirements. However, Nevada law does not require every piece of equipment used for general anesthesia at an adult moderate sedation site. Under NAC 631.2227, a moderate sedation office is not required to have the laryngoscope, endotracheal tubes and connectors, endotracheal tube forcep, electrocardioscope and defibrillator, or capnography monitor unless another rule makes them necessary. The office must still maintain the required patient records and emergency drugs, with the limited exceptions listed in NAC 631.2231.

For patients 12 years of age or younger, Nevada requires the pediatric moderate sedation qualification pathway. To qualify, a dentist must complete either a Board-approved course of at least 60 hours dedicated exclusively to moderate sedation for patients 12 and younger and successfully administer moderate sedation as the operator on at least 25 pediatric patients, or complete CODA-approved specialty training with equivalent pediatric sedation education plus valid PALS or a Board-approved course in medical emergencies and airway management.

A practice may also provide pediatric moderate sedation through another Nevada dentist who holds the proper permit, but the office must first obtain site approval for that location. 

Before the Board issues an original general anesthesia or moderate sedation permit, the dentist and office must pass an inspection and evaluation. That review covers the facility, equipment, personnel, patient records, emergency drugs, and the procedures used in the office, as well as the dentist’s qualifications and performance. The Board may appoint two or more evaluators with the required permit and experience, and at least one evaluator must have experience evaluating dentists in that category of anesthesia or sedation.

The evaluation is hands-on. It includes review of facilities, equipment, records, and emergency medications, plus direct demonstration of administration to a patient receiving dental treatment, simulated emergencies involving trained staff, appropriate monitoring, routine anesthesia or sedation techniques, and patient recovery. The dentist and team must be able to demonstrate management of airway events, bronchospasm, aspiration, cardiac emergencies, allergic reactions, convulsions, hypoglycemia, asthma, respiratory depression, local anesthetic overdose, hyperventilation, syncope, and other emergencies listed in NAC 631.2225.

If a dentist fails the inspection or evaluation, the Executive Director issues written notice identifying the reasons. The dentist must stop administering general anesthesia, deep sedation, or moderate sedation until the required permit is obtained. The dentist may request a reevaluation in writing within 15 days, but no more than one reevaluation may be requested within any 12-month period. If the inspection shows an immediate threat to public health, safety, or welfare, the President of the Board may issue a summary suspension order.

A dental hygienist may administer local anesthesia when the hygienist has completed the required education, has received the Board’s permit or certification for that authority, and has authorization from the licensed dentist of the patient. In a health care facility, it is required that licensed medical personnel and necessary emergency supplies and equipment be available when local anesthesia is administered.

A dental hygienist may administer nitrous oxide-oxygen analgesia when the required training has been completed, the Board has issued the permit or certification, and the patient’s licensed dentist has authorized the service. In a health care facility, it is required that licensed medical personnel and necessary emergency supplies and equipment be available when local anesthesia is administered.

Dentists who hold general anesthesia or moderate sedation permits remain subject to Board review at any time. Those permits renew annually or biennially based on the renewal cycle of the underlying dental license. In addition, the permit holder must complete at least 6 hours every 2 years in study specifically related to anesthesia or sedation before renewal. The Board may also require reevaluation at renewal and must give written notice 60 days before the renewal date if reevaluation will be required. Site approval certificates also renew on the applicable annual or biennial cycle, and the Board may reinspect the office at any time.

For dental hygienists, local anesthesia and nitrous oxide authority is addressed through the hygiene licensure and permit framework rather than the dentist anesthesia/sedation renewal framework. 

General anesthesia and moderate sedation permit holders are required to undergo a 5-year evaluation.  Permit holders are notified by the Board to schedule a 5-year evaluation 90-days prior to the permit's 5-year anniversary.